Comparison Of Verteporfin Photodynamic Therapy Combined With Ranibizumab Versus Ranibizumab Monotherapy In The Treatment Of Wet AMD:a Meta-analysis

Objective:To compare the efficacy and safety of verteporfin photodynamic therapy combined with ranibizumab versus ranibizumab monotherapy in the treatment of wet age-related macular degeneration.Methods:Pubmed, EMbase, The Cochrane Library, CMB, CNKI and WanFang database were searched up to March 2014. There were no language restrictions in the search for trials. All of the relevant randomized controlled trials were included. Methodological quality of the literatures was evaluated according to the Jadad scale. The Cochrane Collaboration’S software Rev Man 5.3 was used to do the meta-analysis.Results:Five randomized control trials in the literature were selected for meta-analysis, a total of 555 patients(565 eyes):a monotherapy group(323 eyes) and a combined treatment group(303 eyes). The results of the meta-analysis showed the following : ① The change in best corrected visual acuity(BCVA):the combined treatment group showed worse therapy effect compared with the monotherapy group and there was a significant difference [WMD=-3.13,95 % CI(-5.50,-0.75), P=0.01]. ② There was no significant difference for the proportion of patients gaining ≥0 letters at month 12 between the two groups [RR=0.95,95%CI(0.82,1.10),P=0.49]. ③The proportion of patients who gained≥15 letters: the combined treatment group was inferior to the monotherapy group and there was a significant difference [RR=0.70,95%CI(0.53,0.93),P=0.01]. ④There was no significant difference for the proportion of patients losing ≥15 letters at month 12 between the two groups [RR=1.51,95%CI(0.91,2.49),P=0.11]. ⑤There was no significant difference for the change in central retinal thickness between the two groups[WMD=-5.86,95%CI(-24.87,13.16),P=0.55].⑥There was no significant difference for the change in lesion size between the two groups[WMD=0.06,95%CI(-0.75,0.87),P=0.89]. ⑦The times of ranibizumab injection had no significant difference between the two groups[WMD=0.06,95%CI(-2.56,0.56),P=0.21]. ⑧Incidence of adverse events: Incidence of ocular adverse events had no significant difference between the two groups[RR=1.08,95%CI(0.90,1.30),P=0.42]; Incidence of nonocular adverse events had no significant difference between the two groups[RR=0.97,95%CI(0.79,1.20),P=0.80].Conclusions:The efficacy of verteporfin photodynamic therapy combined with ranibizumab in gaining BCVA is not better than ranibizumab monotherapy in the treatment of wet age-related macular degeneration. And there was no significant difference for the change in central retinal thickness, the change in lesion size, ranibizumab injection times and Incidence of adverse events between the two groups.